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Diabetes Drugs And Doses > Doses > Flashcards

Doses Flashcards

0
Q

Glipizide

A

2.5-20mg po qd-bid; MDD= 40mg/d

XL: 5-10mg po qd; MDD= 20 mg/d

CrCl: <50; reduce dose by 50%

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1
Q

Glyburide

A

1.25- 20 mg po QD
MDD= 20 mg/d

Beers list; elderly can not use it (<50; do not use anymore

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2
Q

Glimepiride

A

1-4 mg po QD; MDD = 8 mg/day

CrCl <60; monitor

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3
Q

SU side effects

A 
Hypoglycemia
N/V
Weight gain
GI upset
rash
Cholestatic jaundice
Hemolytic anemia
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4
Q

SU interactions

A

OH: flushing, potentiation of hypoglycemia

Displaced protein binding: salicylates, clofibrate, other SU

Decreased Renal excretion: allopurinol, probenacid - increasing concentrations of SU resulting in low BS

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5
Q

SU contraindication

A 
Hypersensitivity
DK
Cl <50 (glyburide)
Pregnancy- 3rd trimester ( glyburide and glipizide only)
T1DM
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6
Q

SU counseling

A

take first thing in the morning 1/2 before breakfast

Take with food
Avoid OH use

A1C lowering of 0.8-2%
Low cost
Reduction in CV events and mortality

Disadv: hypoglycemia, wt. gain, myocardial ischemia preconditioning, low durability

Monitor: hypoglycemia, fbg, wt gain, allegoric reactions (sulfa), increased sun sensitivity

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7
Q

Meglitides : short acting SU

Repaglinide (prandin),
nateglinide (starlix)

A

Short acting secretagoges

Dosing:
Affect post prandial level: take with meals

Nateglinide: 60-120 mg po TID before meals
Repaglinide: 0.5-16 mg po before meals MDD= 16mg/day

SE: hypoglycemia, GI symptoms, headache, caution use in kidney and liver impairment

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8
Q

Meglitinides DDI

A

Nateglinide:
Mifepristone: do not use within 14 days
Pazopanib: increases nateglinide levels

Repaglinide:
Mifepristone: do not use within 14 days
Gemfibrozil: increases repaglinide levels
NPH insulin: increases risk MI (avoid)

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9
Q

Meglitinides CI

A

Hypersensitivity
T1DM
DKA

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10
Q

Meglitinides counseling

A

Administer after meals: 30 minutes:::::::if meal skipped dose skipped

Hypoglycemia & wt gain

Avg A1C lowering 0.6-1.0%

Sane as SU

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11
Q

Biguanides: metformin

Dosing

A

IR: 500, 850, 1000 mg

ER: 500, 750, 1000
MDD= 2550 mg/day

Increase muscle glucose uptake
Decrease glucose output from liver

850-2000 mg po qd-bid
Minimum effective: 500 mg po bid

Optimal dosing:
IR= 850- 1000 mg bid
ER= 1000-2000 mg qd

Given BID; and take with food to decrease SE

SE:
GI: NV, diarrhea
Wt. Loss: lactic acidosis <0.1/1000
Ask abt: SOB, muscle cramping, tachycardia

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12
Q

Biguanide DDI

A

Concentration of: dofetilide, dalfampridine, radioopague contrast dyes increase (stop metformin 24-48 hours before use)

”” decrease: trospium

Metformin concentrations increase with: cimetidine, trimethoprim, lamotrigine

”” decrease: luteinizing hormone

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13
Q

Biguanide CI

A 
Hypersensitivity
Renal disease/dysfunction
Metabolic acidosis
Dka
Lactic acidosis
Iodinated contrast 
Impaired liver function
Hypoxemia
Dehydration
Sepsis
Surgery
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14
Q

Metformin renal doses

A

CrCl: = 1.5 mg/dl in men and 1.4 in women

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15
Q

Biguanides

A

Advantages:
No wt gain or hypoglycemia,
Reduce in CV events and mortality
Low cost

Disadvantage:
GI SE
Vitamin B12 deficiency
Renal function caution
Lactic acidosis (rare)
16
Q

Thiazolidinedoines

Rosiglitazone (Avandia)
Pioglitazone (Actos)

A

Decrease peripheral insulin resistance acting on muscle and adipose tissue

Take once daily; same time each day, avoid oh use

Rosiglitazone (Avandia): 4-8 mg po QD
MDD= 8 mg

Pioglitazone (Actos): 15-30 mg po QD
MDD= 45mg

17
Q

Thiazolidinediones side effects/ DDI

A

Edema
Wt gain (>10 kg) esp with insulin or insulin secretagogues
Hepatic toxicity: rare

Rosiglitazone: insulin, nitrates (inc risk of MI= black box warning)

Pioglitazone: oral contraceptives decreased efficacy, progestins, pazopanib

18
Q

Thiazolidinedoines Contraindications

A 
Hypersensitivity/ T1DM/DKA
ALT >2.5 ULN
NYHA CLASS 3-5 HF
ACS
Active bladder disease
19
Q

Thiazolidinediones

A

Increase HDL; decrease TG
NO HYPERGLYCEMIA

DISADVANTAGE's
Wt gain
Edema
Hf
Bone fracture 
Increase ldl: Rosi
CV warnings
20
Q

Alpha-glucose inhibitors

Acarbose (precose)
Miglitol (glyset)

A

Acarbose: 25 mg po TID; MDD= 50 mg po TID

Miglitol: 25 mg po TID; MDD = 100 mg po TID

Se: abd pain, diarrhea, flatulence

21
Q

Alpha- Glucoside Inhibitors CI/ advant

A

CI: hypersensitivity, DKA, cirrhosis, IBS, clonic ulcerations, intestinal obstruction, Scr

Must take with meal

Advantages:
Not systemic
Decrease PPG

Disadvantage:
GI side effects (flatulence, gas, diarrhea)
Dose frequency
Medium cost

22
Q 
Gliptins (DPP-4 Inhibitors)
Januvia (sitagliptin)
Tradjenta (linagliptin)
Onglyza (saxagliptin)
Nesina (alogliptin)
A

Sitagliptin:
Optimal dose= 100mg qd
30-49 = 50 mg
<15 = 6.25 mg

23
Q

Gliptins SE/DDI

A 
Nasopharyngitis 
URI
Diarrhea
N/v
Headache
Pancreatitis?
Hepatotoxicity

DDI -
Saxa: conivaptan increase con
Trajenta: carbamazepine, efavirenz, phenytoins, rifampins, st. Johns wort decreases con

JANUVIA AND NESIBA HAVE NO DRUG INTERACTIONS

24
Q

Gliptins CI/ counseling

A

Hypersensitivity
T1DM
DKA

Take same time each day with or without food and avoid alcohol

Ask about nasopharyngitis and URI

25
Q

Gliptins adv/disadv

A

Average A1c 0.6-0.8
No hypoglycemia
Wt neutral

Disadv
Uticaria/angioedema
Pancrititis
High cost and unknown safety

Monitor fbg/ppg
Uri and gi intolerance

26
Q

SGLT-2

Invokana (canagliflozin)
Farxiga (dapagliflozin)

A

Canagliflozin: 100 mg po qd
Optimal dose is 300 mg qd
Use only if eGFR is 45-60

Dapagliozin: start at 5mg qam and move to 10mg qam

Avoid when gfr is 30-59

Take once daily same time each day

27
Q

Canagliflozin side effects

A 
Canagliflozin
Yeast infections
UTI
Increased urination
Male genital mycotic infection

Dapagliflozin
Same as canagliflozin
Nasopharyngitis

28
Q

SGLT 2 DDI

A

UGT enzyme inducers
Rafampin, phenytoin, phenobarbital
ACE, arb, diuretics cause hypotension

29
Q

SGLT 2 Contraindication

A

Dialysis
CrCl <30
ESRD

CAUTION: hyperkalemia with canagliflozin, LDL-C levels and bladder cancer with dapagliflozin

Diabetes Drugs And Doses (2 decks)

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